Patient-Reported Outcomes from Supraclavicular Thoracic Outlet Decompression

Q3 Medicine
Kazimir R. Bagdady BS , Jacob A. Thayer MD , Jaclyn Bredenkamp , Brian A. Mailey MD
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Abstract

Purpose

The diagnosis of neurogenic thoracic outlet syndrome is based on patient history, provocative maneuvers, and, ultimately, the successful relief of symptoms following surgical decompression. We sought to understand patient-reported outcomes after thoracic outlet decompression.

Methods

All patients undergoing thoracic outlet decompression between July 2015 and July 2020 were identified from a single institutional database. Validated questionnaires including, Thoracic Outlet Syndrome Index, Short Form 20, Pain Catastrophizing Scale (PCS), Zung Self-Reporting Depression Scale, and nine of our own questions, were used to report patient outcomes from 10 individuals.

Results

The Thoracic Outlet Syndrome Index, Zung Self-Reporting Depression Scale, Short Form 20 pain subscore, and PCS averages were 63 (± 44.3), 58.25 (± 5.04), 40.3 (± 17.5), and 22.6 (± 18.81), respectively. One hundred percent of patients indicated some level of depression with 50% indicating mild levels and 50% indicating moderate levels of depression. Pain was the most commonly reported improved symptom after surgery with 50% indicating a ≥95% improvement. Despite 80% of patients indicating surgery provided the results they were expecting, 60% still had some element of numbness in their arm or hand.

Conclusions

Thoracic outlet decompression can produce high levels of symptom improvement, especially in regards to pain. Lack of improvement can be related to a multitude of factors including confounding depression, pain catastrophizing/neurosis, inaccurate diagnosis of thoracic outlet syndrome, or double crush syndrome. More objective tests for identifying thoracic outlet syndrome may help to better understand which patients have a better likelihood of symptom improvement after surgery.

Type of study/level of evidence

Symptom Prevalence Study III.
锁骨上胸廓减压患者报告的结果
目的神经源性胸廓出口综合征的诊断是基于患者的病史、刺激动作以及手术减压后症状的成功缓解。我们试图了解患者报告的胸廓出口减压后的结果。方法选取2015年7月至2020年7月间接受胸廓出口减压术的所有患者。经验证的问卷包括胸廓出口综合征指数、短表20、疼痛灾难化量表(PCS)、Zung自我报告抑郁量表和我们自己的9个问题,用于报告10名患者的结果。结果胸廓出口综合征指数、Zung自述抑郁量表、Short Form 20疼痛评分和PCS平均值分别为63(±44.3)、58.25(±5.04)、40.3(±17.5)和22.6(±18.81)。100%的患者表现出某种程度的抑郁,其中50%表现为轻度抑郁,50%表现为中度抑郁。疼痛是手术后最常见的改善症状,50%的患者表示改善≥95%。尽管80%的患者表示手术提供了他们预期的结果,但60%的患者仍然有手臂或手部麻木的情况。结论胸廓出口减压术能显著改善症状,尤其是疼痛症状。缺乏改善可能与多种因素有关,包括混杂性抑郁、疼痛灾难/神经症、胸廓出口综合征的不准确诊断或双重挤压综合征。更客观的测试来识别胸廓出口综合征可能有助于更好地了解哪些患者在手术后症状改善的可能性更大。研究类型/证据水平症状患病率研究III。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
111
审稿时长
12 weeks
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